Long-term-care facilities lagging in health IT adoption

They are ineligible for meaningful use incentives but play a crucial role in the connected health system the program is creating.

By — Posted April 9, 2013

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In many ways, long-term and postacute care facilities are in a situation similar to the one many physician practices were in five years ago. They see the value of electronic health record systems, and they are being pressured to purchase one, but they have many barriers to overcome before they can make the investment.

The rate of EHR adoption among long-term care and postacute care facilities has been described as “dismally low.” Unlike their short-term acute care and physician practice counterparts, these organizations are not eligible for meaningful use incentive money. They are, however, a critical piece to the connected health care system the meaningful use program is aimed at creating.

The Health and Human Services Dept. Office of the National Coordinator for Health Information Technology published an issue brief in March that looked at the barriers these facilities face with health IT adoption and how their low adoption rate affects the rest of the health care system (link).

The report said a lack of leadership, resources and organizational skills to acquire and implement health IT has stood in the way of many facilities moving forward with adoption. It also noted that the facilities with technology tend to have systems focused on federal reporting needs and not on exchanging information with other care facilities due to a lack of awareness of the need.

“Although [long-term, postacute care] providers are not eligible providers in the EHR Incentive Program … the ability for [these] providers and facilities to send and receive information with eligible providers and to electronically exchange standardized data bidirectionally between care settings is paramount to the continuity and quality of patient-centered care,” the report said.

Forty percent of Medicare beneficiaries who were discharged from acute care hospitals in 2008 received postacute care, according to the report. For physicians, the ability to exchange information with those facilities will be critical to maintain continuity in the care plans.

A study in Health Affairs in March 2012 found that only 6% of long-term, acute care hospitals and 4% of rehabilitation hospitals had at least a basic EHR system. Short-term, acute care hospitals, by comparison, had an adoption rate of 12% (link). According to the ONC, adoption has since increased to 44% in short-term, acute care hospitals.

Under meaningful use requirements, physicians must have the ability to send and receive care summaries during transitions of care to all health care settings, including long-term and postacute care facilities. Although the lack of an EHR capable of sending and receiving information inside long-term-care facilities may prevent this exchange from taking place, the practices and hospitals going after the meaningful use funds probably won’t be penalized or placed in jeopardy of not receiving a bonus.

ONC spokesman Peter Ashkenaz said eligible physicians are permitted to exchange summaries of care in any way they can, including by fax or mail. For stage 2 of meaningful use, they must send 10% of summary records electronically.

But beyond meaningful use, quality-of-care arguments persist as the lack of information from one care setting to another could present patient safety issues.

The case for electronic exchange

Paper-based methods of information exchange cause physicians to lose a lot of important information, said Majd Alwan, PhD, senior vice president of technology at LeadingAge, a Washington, D.C.-based nonprofit organization for institutions that serve the aging population. Alwan said these documents often lack important data such as medication lists, allergies, functional and cognitive status. He said LeadingAge hopes Congress expands the meaningful use program to include long-term and postacute care facilities.

“We have advocated to include them, but the answer that we’ve gotten was: ‘There isn’t enough money to go around for all types of providers,’ ” said Alwan, executive director of LeadingAge’s Center for Aging Services Technologies.

The ONC report offered several recommendations to improve care coordination with long-term and postacute care facilities, including joining health information exchanges in the community that allow information exchange among disparate systems. The report also suggested low-cost methods of data exchange such as Direct, a secure messaging system developed by the ONC that allows the exchange of patient data between two known and trusted parties. The ONC also recommended that these facilities explore partnerships with other organizations, such as accountable care organizations, that can share resources.

Alwan said LeadingAge is encouraging its members to reach out to other care facilities and physicians to partner with them on Affordable Care Act initiatives and find ways to make information exchange more meaningful for both parties.

“While they don’t have access to the meaningful use incentives, they can make their physician partners and hospital partners more meaningful users of electronic health records,” Alwan said. “They can help them obtain those meaningful use incentives.”

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